Development of a Rapid Blood Transfusion System with the Capability of Blood Purification

Abstract

Blood is usually irradiated by x-ray to prevent graft-versus-host-disease. However, plasma potassium levels of irradiated blood are rapidly increased during preservation in irradiated blood. The objectives of this study were to develop a rapid blood transfusion system for which irradiated blood can be used and to evaluate the capability of blood purification of the system. Packed red blood cells (RBC) were irradiated (15 Gy x-ray) at 21 days and preserved until 42 days after collection. A blood mixture of RBC and plasma was perfused through a dialyzer at 25, 50, 100, and 200 ml/min. Dialysate was perfused at 100, 100, 500, and 500 ml/min, respectively. Preperfusion levels of sodium, 121; potassium, 35; and chlorine, 76 mEq/L were changed to sodium, 144 to 146; potassium 2.5 to 3.0; and chlorine, 105 to 110 mEq/L, which were comparable with the levels in dialysate after perfusion for 25, 50, and 100 ml/min perfusion groups. For the 200 ml/min perfusion group, potassium was 5.3 mEq/L after perfusion which was slightly higher than other groups, but 84% of the potassium was removed by the system. Citrate levels were significantly decreased to 3.4, 28, 31, and 81 mg/dl for the 25, 50, 100, and 200 ml/min groups, respectively, after perfusions. The rapid transfusion system composed of the dialyzer and the blood pumps was effective in the removal of potassium and in the normalization of electrolytes. Irradiated blood with high levels of potassium can be safely and effectively used for this system in cases requiring massive rapid blood transfusion.

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

“…The irradiation process inactivates any viable T-lymphocytes in the donor blood preventing the development of transfusionassociated graft versus host disease (TA-GvHD) in the recipient. Irradiation is an important precaution as there is no effective treatment for TA-GvHD and more than 90% of patients developing the condition die [1]. In addition to T-lymphocytes, donor stem cells may also play a role in TA-GvHD.…”

“…In addition, by the time the red cells are irradiated they may have been stored for up to 2 weeks allowing lactate levels to increase due to anaerobic energy metabolism in the erythrocytes [4]. Several studies have reported extremely high levels of K + along with increased lactate concentrations in units of IRC [1,3,5,6]. This has the potential to lead to complications during and after transfusion.…”

“…A number of studies have used similar devices for the removal of K + and saline washing has been shown to produce an effective K + reduction in all cases [1,12,13]. Modern cell saver devices such as the Dideco Electa (Sorin Group, Italy) used in this study have been designed to minimise haemolysis.…”